Global health beyond the Millennium Development Goals

14 August 2009

Professor Lawrence Gostin

According to Professor Lawrence Gostin, the Director of the O'Neill Institute for National and Global Health Law at Georgetown University's Law Center, there are powerful reasons why rich countries around the world should care more about the world's least healthy people.

Speaking at a seminar on 6 August entitled Global Health Beyond the Millennium Development Goals, as part of the Law School's Distinguished Speakers Program, Professor Gostin was joined by Professor Daniel Tarantola from the University of New South Wales' Health and Human Rights Initiative, and by Professor Roger Magnusson and Dean Professor Gillian Triggs from Sydney Law School.

Dean Professor Gillian Triggs

The seminar was jointly sponsored by the Centre for Health Governance, and the Sydney Centre for International Law, and addressed a theme that is likely to attract increasing attention in future. What kinds of structures and strategies are best suited to advancing global health in the medium term? What kinds of global architecture could best co­ordinate and support the many stakeholders working in this field? And what is the role of interna­tional law, relative to non-legal strategies for encouraging international cooperation?

The Millennium Development Goals are currently the most significant health development program within the United Nations system. There are eight goals which UN agencies and their partners are committed to achieving within a 15 year time-frame (2000-2015). Health is a focus of three goals ("reduce child mortality"; "improve maternal health"; "combat HIV/AIDS, malaria and other diseases"), and improvements in health would also help to achieve other goals for the eradication of extreme poverty and hunger, achieving universal primary education, and improving gender equality. However, as the time-frame for the MDGs draws to a close, what then?

Why care about the world's least healthy people?

In his keynote address, Professor Gostin argued that global health ought to occupy a higher priority for rich countries both for reasons of enlightened self-interest, and because the vast disparities in life expectancies between rich and poor countries, are simply unethical.

It is well known that the "world's communities are interdependent and reliant on one another for health security". Pathogens migrate from less to more developed countries, and epidemics of disease can chill international tourism, trade and commerce. Countries with very poor levels of health can become unreliable suppliers of natural resources and manufactured products, more dependent upon aid and humanitarian assistance, and more vulnerable to civil unrest. This can lead to security problems beyond their own borders.

But global health is also about ethics. Some of the diseases that decimate the lives of those in poor countries- like HIV/AIDS- are also found in rich countries, and therefore have a high profile. But others, "such as elephantiasis, guinea worm, malaria, river blindness, schistosomiasis and trachoma are common in poor countries but are largely unheard of in rich countries".

According to Professor Gostin, "human instinct suggests it is unjust for large populations to have such poor prospects for good health and long life simply by happenstance of where they live". Drawing on what he termed a theory of human functioning, Professor Gostin argued that health enjoys special significance, since it is "necessary for much of the joy, creativity, and productivity that a person derives from life". "Without minimum levels of health, people cannot fully engage in social interactions, participate in the political process, exercise rights of citizenship, generate wealth, create art, and provide for the common security".

Professor Lawrence Gostin

Basic survival needs

But what are the structures through which countries, civil society, private foundations, and other stakeholders can work together cooperatively to improve the health of the world's more unhealthy people? In his keynote address, Professor Gostin reviewed current problems with the delivery of health development assistance, and argued that the priority for the future ought to be to build enduring health systems that are capable of providing for "basic survival needs".

As Professor Gostin pointed out, a health system needs to be able to identify, prevent and treat the major health risks affecting a population, and this requires disease surveillance capabilities, laboratories, and a competent health workforce. Primary health care services are critical, in order to provide maternal and child health care services, family planning and medical treatment in the places where people work and live.

In Professor Gostin's view, collective commitment towards the achievement of these goals could best be achieved through a Framework Convention on Global Health. The Convention itself would set priorities for international attention, including workforce capacity, engage state and non-state stakeholders to contribute resources, and establish a mechanism for the coordination of their activities, and for the monitoring and enforcement of obligations. Specific protocols would be developed over time to achieve the objectives agreed to in the original framework. As experience with the Framework Convention on Tobacco Control shows, the "framework convention-protocol has considerable flexibility, allowing participating states to decide the level of specificity that is politically feasible now, saving more complex or contentious issues to be built in later protocols".

Professor Daniel Tarantola

Neglecting human rights?

In his address, Professor Daniel Tarantola, a former adviser to the World Health Organisation and a pioneer of the health and human rights movement, reviewed the extent to which a human rights-centred approach has featured in global health and development initiatives over time.

The protection of human rights lay at the core of the first global strategy on HIV/AIDS, pioneered in 1986 by the late Harvard Professor Jonathan Mann, Professors Tarantola, Gostin, Gruskin, former High Court Justice (and Sydney Law School alumnus) Michael Kirby, and others. During the 1990s, Professor Tarantola and others promoted an expanded approach to human rights which encompassed both the protection of the human rights of those whose behaviours impacted on the health of the community, as well as a commitment to the structural and societal factors that impact on risk and vulnerability.

Professor Tarantola pointed out that by 2000, when the Millennium Development Declaration was adopted, the human right to development had gained an increasing profile. Unlike the Declaration, however, the Millennium Development Goals make no explicit appeal to human rights. In 2005, former UN Secretary General Kofi Annan wrote: "We will not enjoy security without development, and we will not enjoy either without respect for human rights. Unless all these causes are advanced, none will succeed".

In early July 2009, however, when UN Secretary General Ban Ki-moon presented the latest UN report on progress towards the MDGs, the report again made no mention of human rights. According to Professor Tarantola, "The WHO Commission on the Social Determinants of Health did a remarkable job highlighting some of the key social determinants of health, but failed to question their dependency on the realisation of human rights- the true determinants of the social determinants of health".

From left to right: Professor Daniel Tarantola, Professor Lawrence Gostin, Professor Gillian Triggs and Professor Roger Magnusson

In Professor Tarantola's view, the failure of government and non-government institutions alike to address health, development and human rights in a coordinated, rather than an isolated manner, comes at a cost. "[A] mix of investments may, together, result in advancing health, development and human rights more effectively", he said.

In a short paper, Professor Magnusson reviewed the challenge of coordinating the multiple initiatives that characterise the global health environment. He reviewed recent initiatives for responding to chronic, non-communicable diseases, and outlined a basic framework for making sense of global governance for chronic diseases, even in the absence of ideal governance structures.

Studying health law at Sydney Law School

Sydney Law School offers a range of units in health law and public health law as part of its Master of Health Law, Graduate Diploma in Health Law, and Graduate Diploma in Public Health Law. Please visit Health Law program for more information about the Master of Health Law program.

Please visit the Centre for Health Governance, Law & Ethics and the Sydney Centre for International Law for further information about the centres.

For further information about the health law teaching program, contact either of its co-convenors, Professor Roger Magnusson or Dr Kristin Savell.

For further information about Centre activities, contact the Centre Director, Professor Belinda Bennett. For application forms and other information about enrolment, please contact the the Postgraduate Team.